Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica

Christian Dejaco^{1

2}, Andreas Kerschbaumer³, Daniel Aletaha⁴, Milena Bond², Elvis Hysa⁵, Dario Camellino⁶, Lisa Ehlers⁷, Andy Abril⁸, Simone Appenzeller⁹, Maria C Cid¹⁰, Bhaskar Dasgupta¹¹, Christina Duftner¹², Peter C Grayson¹³, Bernhard Hellmich¹⁴, Alojzija Hočevar^{15

16}, Tanaz A Kermani¹⁷, Eric L Matteson¹⁸, Susan P Mollan^{19

20}, Lorna Neill²¹, Cristina Ponte^{22

23}, Carlo Salvarani^{24

25}, Sebastian Eduardo Sattui²⁶, Wolfgang A Schmidt²⁷, Philip Seo²⁸, Josef S Smolen²⁹, Jens Thiel^{30

31}, Carlos Enrique Toro-Gutiérrez³², Madeline Whitlock³³, Frank Buttgereit³⁴

Affiliations

¹ Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Medical University, Graz, Austria christian.dejaco@gmx.net.
² Rheumatology, Hospital of Bruneck (ASAA-SABES), Teaching Hospital of the Paracelsius Medical University, Brunico, Italy.
³ Abteilung für Rheumatologie, Medizinische Universitat Wien Universitatsklinik fur Innere Medizin III, Wien, Austria.
⁴ Department of Rheumatology, Medizinische Universität Wien, Wien, Austria.
⁵ Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, University of Genoa, Genova, Italy.
⁶ Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, Arenzano, Italy.
⁷ Department of Rheumatology and Clinical Immunology, Charite Medical Faculty Berlin, Berlin, Germany.
⁸ Rheumatology, Mayo Clinic, Jacksonville, Florida, USA.
⁹ Departamento de Clínica Médica. Facultade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brazil.
¹⁰ Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
¹¹ Rheumatology, Southend Hospital NHS Trust, Westcliff-on-sea, UK.
¹² Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria.
¹³ National Institutes of Health/NIAMS, Bethesda, Maryland, USA.
¹⁴ Klinik für Innere Medizin, Rheumatolgie und Immunologie, Medius Kliniken Kirchheim/Teck, University Tübingen, Kirchheim-Teck, Germany.
¹⁵ Department of Rheumatology, Universitiy Medical Centre, Ljubljana, Slovenia.
¹⁶ Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
¹⁷ Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
¹⁸ Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
¹⁹ Ophthalmology, University Hospitals Birmingham, Birmingham, UK.
²⁰ Neurometabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
²¹ Patient Charity Polymyalgia Rheumatica and Giant Cell Arteritis Scotland, Nethy Bridge, UK.
²² Rheumatology, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal.
²³ Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal.
²⁴ Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy.
²⁵ Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.
²⁶ Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
²⁷ Rheumatology, Immanuel Krankenhaus Berlin, Berlin-Buch, Berlin, Germany.
²⁸ Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA.
²⁹ Rheumatology, Medical University of Vienna, Wien, Austria.
³⁰ Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Medical University, Graz, Austria.
³¹ Clinic for Rheumatology and Clinical Immunology, University Hospital Freiburg, Faculty of Medicine, Freiburg, UK.
³² Reference Center in Osteoporosis, Rheumatology & Dermatology, Pontificia Universidad Javeriana Cali Facultad de Ciencias de la Salud, Cali, Colombia.
³³ Rheumatology, Southend University Hospital, Southend, UK.
³⁴ Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.

PMID: 36828585
PMCID: PMC10803996
DOI: 10.1136/ard-2022-223429

Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica

Christian Dejaco et al. Ann Rheum Dis. 2024.

. 2024 Jan 2;83(1):48-57.

doi: 10.1136/ard-2022-223429.

Authors

Affiliations

¹ Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Medical University, Graz, Austria christian.dejaco@gmx.net.
² Rheumatology, Hospital of Bruneck (ASAA-SABES), Teaching Hospital of the Paracelsius Medical University, Brunico, Italy.
³ Abteilung für Rheumatologie, Medizinische Universitat Wien Universitatsklinik fur Innere Medizin III, Wien, Austria.
⁴ Department of Rheumatology, Medizinische Universität Wien, Wien, Austria.
⁵ Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, University of Genoa, Genova, Italy.
⁶ Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, Arenzano, Italy.
⁷ Department of Rheumatology and Clinical Immunology, Charite Medical Faculty Berlin, Berlin, Germany.
⁸ Rheumatology, Mayo Clinic, Jacksonville, Florida, USA.
⁹ Departamento de Clínica Médica. Facultade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brazil.
¹⁰ Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
¹¹ Rheumatology, Southend Hospital NHS Trust, Westcliff-on-sea, UK.
¹² Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria.
¹³ National Institutes of Health/NIAMS, Bethesda, Maryland, USA.
¹⁴ Klinik für Innere Medizin, Rheumatolgie und Immunologie, Medius Kliniken Kirchheim/Teck, University Tübingen, Kirchheim-Teck, Germany.
¹⁵ Department of Rheumatology, Universitiy Medical Centre, Ljubljana, Slovenia.
¹⁶ Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
¹⁷ Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
¹⁸ Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
¹⁹ Ophthalmology, University Hospitals Birmingham, Birmingham, UK.
²⁰ Neurometabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
²¹ Patient Charity Polymyalgia Rheumatica and Giant Cell Arteritis Scotland, Nethy Bridge, UK.
²² Rheumatology, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal.
²³ Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal.
²⁴ Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy.
²⁵ Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.
²⁶ Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
²⁷ Rheumatology, Immanuel Krankenhaus Berlin, Berlin-Buch, Berlin, Germany.
²⁸ Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA.
²⁹ Rheumatology, Medical University of Vienna, Wien, Austria.
³⁰ Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Medical University, Graz, Austria.
³¹ Clinic for Rheumatology and Clinical Immunology, University Hospital Freiburg, Faculty of Medicine, Freiburg, UK.
³² Reference Center in Osteoporosis, Rheumatology & Dermatology, Pontificia Universidad Javeriana Cali Facultad de Ciencias de la Salud, Cali, Colombia.
³³ Rheumatology, Southend University Hospital, Southend, UK.
³⁴ Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.

PMID: 36828585
PMCID: PMC10803996
DOI: 10.1136/ard-2022-223429

Abstract

Objectives: To develop treat-to-target (T2T) recommendations in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR).

Methods: A systematic literature review was conducted to retrieve data on treatment targets and outcomes in GCA/PMR as well as to identify the evidence for the effectiveness of a T2T-based management approach in these diseases. Based on evidence and expert opinion, the task force (29 participants from 10 countries consisting of physicians, a healthcare professional and a patient) developed recommendations, with consensus obtained through voting. The final level of agreement was provided anonymously.

Results: Five overarching principles and six-specific recommendations were formulated. Management of GCA and PMR should be based on shared decisions between patient and physician recognising the need for urgent treatment of GCA to avoid ischaemic complications, and it should aim at maximising health-related quality of life in both diseases. The treatment targets are achievement and maintenance of remission, as well as prevention of tissue ischaemia and vascular damage. Comorbidities need to be considered when assessing disease activity and selecting treatment.

Conclusion: These are the first T2T recommendations for GCA and PMR. Treatment targets, as well as strategies to assess, achieve and maintain these targets have been defined. The research agenda highlights the gaps in evidence and the need for future research.

Keywords: Biological Therapy; Giant Cell Arteritis; Outcome and Process Assessment, Health Care; Polymyalgia Rheumatica.

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Conflict of interest statement

Competing interests: CDe has received consulting/speaker’s fees from Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Sparrow, Roche, Galapagos and Sanofi, all unrelated to this manuscript. He is an editorial board member of ARD. AK has received consultancy fees, honoraria and travel expenses from AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Gilead, Janssen, Merck Sharp and Dohme, Novartis, UCB and Pfizer, all unrelated to this manuscript. He is an editorial board member of ARD. DA received grants, speaker fees, and/or consultancy fees from Abbvie, Amgen, Galapagos, Lilly, Janssen, Merck, Novartis, Pfizer, Sandoz and Sanofi. He is an editorial board member of ARD. MB has received consulting fees from AbbVie. DC has received speaker fees from Abiogen, BMS and GSK. MCC received consultancy and/or speaker fees from GSK, Vifor, Abbvie, Astra Zeneca and Janssen and a research grant form Kiniksa Pharmaceuticals. BD has received consultancies from Novartis, Abbvie, Roche and speaker agreements from Chugai. CDu has received consultancy or speaker fees and travel expenses from Abbvie, AOP Orphan, Astra-Zeneca, Bristol-Myers-Squibb, Eli-Lilly, Janssen, Galapagos, Merck-Sharp-Dohme, Novartis, Pfizer, Roche, Sandoz, UCB, Vifor and research support by Eli-Lilly, Pfizer, UCB, all unrelated to this manuscript. BH received speaker fees and/or consultancies from Abbvie, Amgen, Astra-Zeneca, BMS, Boehringer, Chugai, GSK, InflaRx, Janssen, MSD, Pfizer, Novartis, Phadia, Roche and Vifor. ELM has received consulting fees from Boehringer-Ingelheim, Horizon Therapeutics, Alvotech Inc; speaker fees from Boehringer-Ingelheim; royalties from UpToDate. SPM has received consultancy fees (Invex Therapeutics); advisory board fees (Invex therapeutics; Gensight) and speaker fees (Heidelberg engineering; Chugai-Roche Ltd; Allergan; Santen; Teva UK; Chiesi; and Santhera). All unrelated to this manuscript. LN has received consulting fees from AbbVie. CP is or has been the principal investigator of studies by AbbVie, Sanofi and Novartis and has received consulting/speaker’s fees from Vifor, AstraZeneca, GlaxoSmithKline and Roche, all unrelated to this manuscript. CS has received consultancy fees from Abbvie, Boehringer-Ingelheim, Eli Lilly, Galapagos, Novartis, Pfizer and Roche and royalties from UpToDate. All unrelated to this manuscript. SES has received research support by Astra-Zeneca and has done provided unpaid consultancy for Sanofi. SES is supported by the Rheumatology Research Foundation RISE pilot award and Bristol Myers Squibb Foundation Robert A Winn Diversity in Clinical Trials Career Development Award, outside of the submitted work. WAS has received consultancy fees, honoraria and travel expenses from Abbvie, Amgen, Bristol-Myers Squibb, Chugai, GlaxoSmithKline, Johnson & Johnson, Medac, Novartis, Roche, and Sanofi and is principal investigator in trials sponsored by Abbvie, Amgen, GlaxoSmithKline, Novartis, Roche and Sanofi. PS has received consultancy fees from Amgen and Janssen and royalties from UpToDate, all unrelated to this manuscript. JSS received grants to his institution from Abbvie, AstraZeneca, Lilly, Novartis and Roche and provided expert advice for, or had symposia speaking engagements with, AbbVie, Amgen, AstraZeneca, Astro, Bristol-Myers Squibb, Celltrion, Chugai, Gilead, Janssen, Lilly, Merck Sharp & Dohme, Novartis-Sandoz, Pfizer, R-Pharm, Roche, Samsung, Sanofi and UCB. He is the editor in chief of ARD. JT has received consultancy or speaker fees Bristol-Myers-Squibb, Novartis, Glaxo-Smith-Kline, Astra-Zeneca, Janssen, Abbvie, Eli-Lilly. All unrelated to this manuscript. CET-G has received consultancy fees, honoraria and travel expenses from Abbvie, BMS, Boehringer Ingelheim, Biopas, Janssen, Pfizer, Pharmalab, Roche, all unrelated to this manuscript. FB has received consultancy fees, honoraria and travel expenses from Abbvie, Novartis, Pfizer, Roche and Sanofi, all unrelated to this manuscript. He is an editorial board member of ARD. EH, LE, AA, SA, PCG, AH, TAK and MW declare no competing interests.

References

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Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica

Affiliations

Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica

Authors

Affiliations

Abstract

Conflict of interest statement

References

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